Individual
AMANDA J COLLISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
1239 E MAIN ST, BARTOW, FL 33830-5058
(863) 519-0575
Mailing address
PO BOX 1559, BARTOW, FL 33831-1559
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH13971
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016650700
—
FL
Enumeration date
02/23/2015
Last updated
06/07/2016
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